Original research| Volume 7, ISSUE 2, P111-118, July 2013

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Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes

Published:November 28, 2012DOI:



      To explore the impact of pictorial image and teach back educational strategies on knowledge, adherence to medication and diet among patients with type 2 diabetes and low health literacy in Saqqez, Iran.


      In this randomized controlled trial, 127 patients with type 2 diabetes who had low health literacy were randomly allocated into three arms of the study (pictorial image, teach back, and control groups). The two intervention groups received education within three weekly sessions, each lasting 20 min. The level of functional health literacy in adults (TOFHLA), diabetes knowledge, and adherence to medication and diet were measured and compared in the three groups before and six weeks after the interventions. We used intention to treat analysis. Data were analyzed using ANOVA and Paired t test.


      Mean scores of knowledge, adherence to medication and diet revealed significant differences between two intervention groups and control group (P < 0/001) six weeks after intervention.


      Both educational strategies increased knowledge, as well as adherence to medications and diet among patients with type 2 diabetes and low health literacy. Both educational strategies seem to be effective for patients with low health literacy and are recommended to be used according to patients’ conditions.


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